NCG200476_MONITORING INFO_20171002

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
Iv U& ,:� of f -
DOC TYPE
❑ HISTORICAL FILE
-� MONITORING REPORTS
DOC DATE
❑ a b 1 -� /'9 b
YYYYM M D D

Nd Atlantic
Enginooring 8 Environmental Solutions
September 12, 2017
NCDEQ/DWR
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: STORMWATER SAMPLING RESULTS
FOSS RECYCLING, INC.
3270 FROG LEVEL ROAD
GREENVILLE, PITT COUNTY, NORTH CAROLINA
CERTIFICATE OF COVERAGE NCG200476
MID -ATLANTIC JOB NO. 00OR2066.02
To Whom It May Concern:
909 Rosen View Coun
Rafagh, NC 27610
office 919 2509918
6tvm11e 919 250 9950
MAAONLINE.COM
Attached please find the Stormwater Discharge Monitoring Report (DMR) and analytical report for
the sampling conducted at the above -referenced site. A stormwater sample was collected from
Outfall No. 1 on August 29, 2017 and analyzed for TSS, pH, copper, lead, zinc, oil and grease and
chemical oxygen demand. As indicated on the attached DMR, copper was reported at a
concentration in excess of the benchmark value for the current sampling event. All other
parameters were reported below or within their respective benchmark values. Based on these
results, a Tier One Response has been implemented at the facility. If you have any questions or
need additional information, please contact me at 919-250-9918.
Sincerely,
MID -ATLANTIC ASSOCIATES, INC.
C�-
Charles B. Hoffman, PG
Project Geologist
Attachments: Stormwater Discharge Monitoring Report
Laboratory Analytical Report
RECEIVED
OCT 02 2017
GRNTRAL FILES
DWR SECTION
EXPERIENCED CUSTOMER -FOCUSED INNOVATIVE

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG200000 — Scrap Metal Recycling
Date submitted September 2017
CERTIFICATE OF COVERAGE NO. NCG200476
FACILITY NAME Foss Recycling, Inc. — Greenville, NC Facility
COUNTY Pitt County
PERSON COLLECTING SAMPLES Cameron Shirley
LABORATORY Pace Analytical Lab Cert. # 12
Comments on sample collection or analysis: Rainfall totals pulled
from Weather Underground
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow [_]WaterSupply ❑SA
❑Saltwater ®Other C; NSW
PLEASE REMEMBER TO SIGN ON THE REVERSE -310
No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended
Solids
Chemical Oxygen
Demand
Non -polar oil & grease
EPA Method 1664
(SGT-HEM)
Copper,
Total
Lead,
Total
Zinc,
Total
Benchmarks =_>
-
-
100 mg/L or
50 mg/L4
120 mg/L
15 mg/L
0.010 mg/L or
0.005 mg/L'
0.075 mg/L or
0.210 mg/Ls
0.126 mg/L or
0.090 mg/L'
Outfall No. 1
08/29/17
0.23
<18.5
45.0
<5.0
0.0493
<0.005
0.0257
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3 or Table 4, identifying protected receiving water classifications where the more protective TSS benchmark applies.
5 Stormwater discharges into receiving waters classified as saltwater are subject to the second listed benchmark.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit.
Permit Date: 02/02/2015-12/31/2019 SWU-256, last revised 1/28/2015
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 50 mg/L4
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark you must implement Tier 1 Tier 2 or Tier 3 responses. See General Permit.
FOR PART AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER ATANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
..;i (:� P
(Signature of
q.; q. i
(Date)
Permit Date: 02/02/2015-12/31/2019 SWU-256, last revised 1/28/2015
Page 2 of 2

aceAnalytical
wxwpacela6s.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
September 11, 2017
Chuck Hoffman
Mid -Atlantic Associates, Inc
409 Rogers View Court
Raleigh, NC 27610
RE: Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
Dear Chuck Hoffman:
Enclosed are the analytical results for sample(s) received by the laboratory on August 30, 2017. The
results relate only to the samples included in this report. Results reported herein conform to the most
current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual, where
applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Nicole Gasiorowski
[e-mail]
[phone]
Project Manager
Enclosures
cc: Ron Davis, Mid Atlantic Associatees, Inc.
p PC"
TNI
`9BORPSO?,
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 14

'ceAnalyticala
w ..paodahs.=
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Hunlersville, NC 28078
[phone]
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
CERTIFICATIONS
South Carolina Certification #: 99006001
North Carolina Drinking Water Certification #: 37706 Florida/NELAP Certification #: E87627
North Carolina Field Services Certification #: 5342 Kentucky UST Certification #: 84
North Carolina Wastewater Certification #: 12 VirginiaNELAP Certification #: 460221
Asheville Certification IDs
2225 Riverside Drive, Asheville, INC 28804
North Carolina Wastewater Certification #: 40
Florida/NELAP Certification #: E87648
South Carolina Certification #: 99030001
Massachusetts Certification #: M-NC030
VirginiaNELAP Certification #: 460222
North Carolina Drinking Water Certification #: 37712
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 2 of 14

aceAnalytical
mwpacafabs.=
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
Lab ID Sample ID
92353351001 Outfall No. 1
SAMPLE ANALYTE COUNT
Method
Analysts
Analytes
Reported
Laboratory
EPA 1664E
JMS
1
PASI-C
EPA 200.7
SER
5
PASI-A
SM 2540D
NAL
1
PASI-A
SM 5220D
MVC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
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weAnalytical®
~.pacelaos.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
Sample: Outfall No. 1 Lab ID: 92353351001 Collected: 08/29/17 03:00 Received: 08/30/17 09:30 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
HEM, Oil and Grease
Analytical Method: EPA 1664E
Oil and Grease
ND mg/L
5.0
1
09/11/17 05:22
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation
Method:
EPA
200.7
Cadmium
ND ug/L
1.0
1
09/07/17 20:00
09/10/17 16:15
7440-43-9
Copper
49.3 ug/L
5.0
1
09/07/17 20:00
09/10/17 16:15
7440-50-8
Iron
363 ug/L
50.0
1
09/07/17 20:00
09/10/17 16:15
7439-89-6
Lead
NO ug/L
5.0
1
09/07/17 20:00
09/101W 16:15
7439-92-1
Zinc
25.7 ug/L
10.0
1
09/07/17 20:00
09/10/17 16:15
7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
ND mg/L
18.5
1
08/31/17 01:16
5220D COD
Analytical Method: SM 5220D
Chemical Oxygen Demand
45.0 mg/L
25.0
1
08/31/17 23:00
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 09/11 /2017 03:24 PM without the written consent of Pace Analytical Services, LLC.
Page 4 of 14

aceAnalytical
wwwpacelabs.som
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
OC Batch: 377090
Analysis Method:
EPA 1664E
QC Batch Method: EPA 1664E
Analysis Description:
1664 HEM, Oil and Grease
Associated Lab Samples: 92353351001
METHOD BLANK: 2089068
Matrix: Water
Associated Lab Samples: 92353351001
Blank Reporting
Parameter Units
Result Limit
Analyzed Qualifiers
Oil and Grease mg/L
NO 5.0 09/11/17 05:19
LABORATORY CONTROL SAMPLE: 2089069
Spike LCS
LCS %Rec
Parameter Units
Conc. Result
%Rec Limits Qualifiers
Oil and Grease mg/L
40 38.5
96 78-114
MATRIX SPIKE SAMPLE: 2089070
92353349001 Spike
MS MS % Rec
Parameter Units
Result Conc.
Result %Rec Limits Qualifiers
Oil and Grease . mg/L
ND 40
38.5 95 78-114
Results presented on this page are in the units indicated by the "Units" column accept where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced except in full,
Date: 09/11/2017 03:24 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 14

aceAnalytical®
wwurpacelabs.awn
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
QC Batch: 376608
Analysis Method: EPA 200.7
QC Batch Method: EPA 200.7
Analysis Description: 200.7 MET
Associated Lab Samples: 92353351001
METHOD BLANK: 2086510
Matrix: Water
Associated Lab Samples: 92353351001
Blank
Reporting
Parameter
Units
Result
Limit
Analyzed Qualifiers
Cadmium
ug/L
NO 1.0
09/09/17 21:12
Copper
ug/L
ND 5.0
09/09/17 21:12
Iron
ug/L
ND 50.0
09109/1721:12
Lead
ug/L
ND 5.0
09/09/17 21:12
Zinc
ug/L
ND 10.0
09/09/17 21:12
LABORATORY CONTROL SAMPLE: 2086511
Spike
LCS
LCS % Rec
Parameter
Units
Conc.
Result
% Rec Limits Qualifiers
Cadmium
ug/L
500
464
93 85-115
Copper
ug/L
500
474
95 85-115
Iron
ug/L
5000
4650
93 85-115
Lead
ug/L
500
459
92 85-115
Zinc
ug/L
500
471
94 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
2086512
2086513
MS
MSD
92352416001
Spike
Spike MS
MSD MS MSD
% Rec
Parameter Units
Result
Conc
Conc Result
Result %Rec %Rec
Limits
RPD Qual
Cadmium ug/L
0.0051
500
500 441
437 87 86
70-130
1
mg/L
Copper ug/L
0.14
500
500 642
636 101 100
70-130
1
mg/L
Iron ug/L
4.7
5000
5000 8760
8870 81 83
70-130
1
mg/L
Lead ug/L
0,019
500
500 445
436 85 84
70-130
2
mg/L
Zinc ug/L
0.99
500
500 1400
1410 82 84
70-130
1
mg/L
MATRIX SPIKE & MATRIX
SPIKE DUPLICATE:
2086514
2086515
MS
MSD
92352910001
Spike
Spike
MS
MSD
MS
MSD
% Rec
Parameter
Units
Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
Qual
Cadmium
ug/L
ND
500
500
859
448
172
89
70-130
63
M1,R1
Copper
ug/L
ND
500
500
928
510
186
102
70-130
58
M1,R1
Iron
ug/L
ND
5000
5000
8820
4860
176
97
70-130
58
M1,R1
Lead
ug/L
ND
500
500
836
441
167
88
70-130
62
M1,R1
Results presented on this page are in the units Indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 09/11/2017 03:24 PM without the written consent of Pace Analytical Services, LLC.
Page 6 of 14

acmnalytical
w pacefab&com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2086514 2086515
MS MSD
92352910001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Dual
Zinc ug/L ND 500 500 872 476 174 95 70-130 59 M1,R1
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 09/11/2017 03:24 PM without the written consent of Pace Analytical Services, LLC.
Page 7 of 14

aceAnalytical
www.pacefabs.corn
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Hunlersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
OC Batch: 375843 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92353351001
METHOD BLANK: 2081914 Matrix: Water
Associated Lab Samples: 92353351001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L NO 2.5 08/31/17 01:09
LABORATORY CONTROL SAMPLE:
2081915
Parameter
Units
Total Suspended Solids
mg/L
SAMPLE DUPLICATE: 2081916
Parameter
Units
Total Suspended Solids
mg/L
SAMPLE DUPLICATE: 2081917
Parameter
Total Suspended Solids
Spike LCS LCS % Rec
Conc. Result % Rec Limits Qualifiers
250 254 102 90-110
92352892001 Dup
Result Result RPD Qualifiers
12.8 15.2 17 D6
92353332006 Dup
Units Result Result
mg/L 9.0 9.1
RPD Qualifiers
1
Results presented on this page are in the units indicated by the "Units" column except where an altem ate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 09/11/2017 03:24 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 14

aceAnalytical
awwpamla6s.cwn
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
QC Batch: 375853 Analysis Method: SM 5220D
QC Batch Method: SM 5220D Analysis Description: 5220D COD
Associated Lab Samples: 92353351001
METHOD BLANK: 2081935
Associated Lab Samples: 92353351001
Parameter Units
Chemical Oxygen Demand mg/L
LABORATORY CONTROL SAMPLE: 2081936
Parameter Units
Chemical Oxygen Demand mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 25.0 08/31/1723:00
Spike LCS LCS e/ Rec
Cones Result % Rec Limits Qualifiers
750 764 102 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2081937 2081938
MS MSD
92352704001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 131 750 750 850 850 96 96 90-110 0
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2081939 2081940
MS MSD
92352875002 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 7610 750 750 8580 7920 129 41 90-110 8 M6,R7
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 09/11/2017 03:24 PM without the written consent of Pace Analytical Services, LLC.
Page 9 of 14

aceAnalytical
a ..pamlabs.wm
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALIFIERS
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
NO - Not Detected at or above adjusted reporting limit.
TNTC -Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
PQL- Practical Quantitation Limit.
RL- Reporting Limit.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unfounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
M7 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
M6 Matrix spike and Matrix spike duplicate recovery not evaluated against control limits due to sample dilution.
R1 RPD value was outside control limits.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Dale: 09/11/2017 03:24 PM without the written consent of Pace Analytical Services, LLC. Page 10 of 14

aceAnalytical
wwwpacela6s.cnm
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Foss Recycling Inc -Greenville
Pace Project No.: 92353351
Lab ID
Sample ID
QC Batch Method
QC Batch Analytical Method
92353351001
Outfall No. 1
EPA 1664B
377090
92353351001
Outfall No. 1
EPA 200.7
376608 EPA 200.7
92353351001
Outfall No. 1
SM 2540D
375843
92353351001
Outfall No. 1
SM 5220D
375853
Date: 09/11/2017 03:24 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Analytical
Batch
376874
Page 11 of 14

Document Name: I Document Revised: August 4, 2017
Sample Condition Up on Receipt(SCUR) Page 1 of 2
Documen[No.: ! Issuing Authority:
aceAn31ytlCal
F-CAR-CS-033-Rev.04 1, Pace Quality Office
Laboratory receiving samples:
Asheville ❑ Eden❑ Greenwood ❑ Huntersville Ralelgh❑ Mechanicsville[]
Cli/epn't Nary/fie:
Protect: WO# : 92353351
• / ' 1 �/%1 ! I I �'1, / I�I1 �: Jj/"j/�'�'��
Courier: ed Ex ❑UPS ❑USPS J, ❑Client II I II� I I III I 11111111111
�I �I II �II
❑ Commercial ❑Pace [-]Other: 92393381
Custody Seal Present? ❑Yes _QNO Seals Intact? ❑yes A3TTo
Date/initials Person Examining Contents:
Packing Material: []Bubble Wrap JQ Bubble Bags [-]None ❑ Other Biological Tissue Frozen?
Thermometer: ❑Yes,O� ❑N/A
©Wet ❑Blue ❑None
•—Q IR Gun to: 1 � Typo p11ce:
Correction Factor: Cooler Temp Corrected (•Cj: I J, �t Temp should be above freezing to VC
L�
❑Samples out of temp criteria. Samples on ice, coaling process
has begun
USDA Regulated 5oi1-B-N/A, water sample(
Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check mapsl? Did samples originate from a foreign source (internationally,
I—lyes Irmo including Hawaii and Pueno l l? ❑Yes No
Comments/D)screpancy:
Chain of Custody Present?
Yes
No
N/A
1.
Samples Arrived within Hold Time?
Yes
No
N/A
2.
Short Hold Time Analysis(<72 hr.)?
Yes.i,(rNo
❑N/A
3.
Rush Turn Around Time Requested?
Yes
a
N/A
A,
Sufficient Volume?
Over
o
❑N/A
Correct Containers Used?
-Pace Containers Used?
—Ewre's
Qind
❑No
FINo
❑N/A
N/A
lk
U
Containers Intact?
Yes
No
N/A
7.
Dissolved analysis: Samples Field Filtered?
CYes
N/A
B.
Sample Labels Match COC?
-Includes Date/Time/10/Analysis Matrix:
❑Yes
No
[]N/A
9.
"1� (,• IVC°
Headspace in VOA Vials (>5-bmm)?
❑Yes
❑No
QUIA
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
Oyes
Yes
❑No
❑No
A;JXrA
N/A
11.
CLIENT NOTIFICATION/RESOLUTION
Person Contacted:
Comments/Sample Discrepancy:
Lot ID of split containers:
Date/Time:
Field Data Required? ❑Yes ❑No
Project Manager SCURF Review: lig`� � Date: a
V
Project Manager SRF Review: � 1 y L Date: N ?30 \;�7
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form Mill be sent to the North Carolina DEHNR Certification Office (i.e.
Out of hold, incorrect preservative, out of temp, incorrect containers)
Page 12 of 14

Document Name:
Document Revised: August 4, 2017
f c..'Analytical
Sample Condition Upon Receipt(SCUR)
Page 2 of 2
Document No.:
F-CAR-CS-033•Rev.04
Issuing Authority:
Pace Quality Office
'Check mark top half of box if pH and/or dechlorination
is verified and within the acceptance range for
preservation samples.
"Bottom half of box is to list number of bottles
Project H WO# : 92353351
PM: NMG Due Date: 09/11/17
CLIENT: 92-MID ATLAN
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Sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservation
adjusted
Amount of Preservative
added
Lot a
Page 13 of 14

CHAIN -OF -CUSTODY / Analytical Request Document
The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.
Section A
Section B Section C
Required Client Information:
Required Project Information: Invoice Information: Pa e : 1 Of 1
I RePon To Chuck Holtman (rhoffma aoNine.w Apemion: Chuck Hoffman
lCo,, To Company Name: Mid -Atlantic Associates. Inc
Company Mid -Atlantic Associates
Address: 409 Rapers view Court
Raleipn. NC 2i6t0
Address: 4M Roasts view Coi Raleigh. NC
og
Regulatory Agency
Email To en°Ifman maaonllne corn
PurUvse Older e: R2056.02 In..
Quote:
Phone: [phone]E IF. 9192r 50
Projed Name: Foss Recycling. Im. -Greenville
Pace Project Manage[ Nicole GaslofOwSki
State I Location '
Requested Due Date, standard
Prolecl Numhe[ R2066.00 Task 200000 lP.ca
Profile a: 5921
NO
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2
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4
6
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6
7
8
9
10
11
12
AOOITIONAL COMMENTS
RELINQUISHED BY I AFFILIATION
DATE
TIME
CCEPTED BY AFFILIATION
DATE
TIME
SAMPLE CONDITIONS
C�.
SAMPLER NAME AND SIGNATURE
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UNN
Mid Atlantic
Engineering & Environmental Solutions
February 1, 2016
hc��C �7�
NCDEQ/DWR
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: STORMWATER SAMPLING RESULTS
FOSS RECYCLING, INC.
3270 FROG LEVEL ROAD
GREENVILLE, PITT COUNTY, NORTH CAROLINA
CERTIFICATE OF COVERAGE NCG200476
MID -ATLANTIC JOB NO. 000112066.00
To Whom It May Concern:
409 Rogers View Court
Raleigh, NC 27610
office 919.250.9918
facsimile 919.250,9950
MAAONLINE.COM
f eeiix ©
1CSN B 2016
pwR �C77 NS
Attached please find the Stormwater Discharge Monitoring Report (DMR) and analytical report for
the sampling conducted at the above -referenced site. A stormwater sample was collected from
Outfall 001 on December 31, 2015 and analyzed for TSS, pH, copper, lead, zinc, oil and grease
and chemical oxygen demand. The analytical results reported copper in excess of its established
benchmark value. All other parameters were reported below or within their respective benchmark
values. Based on these results, a Tier One Response has been implemented at the facility. If you
have any questions or need additional information, please contact me at 919-250-9918.
Sincerely,
MID -ATLANTIC ASSOCIATES, INC.
Ron J. Davis
Stormwater Service Manager
Attachments: Stormwater Discharge Monitoring Report
Laboratory Analytical Report
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG200000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO. NCG200476 Mail original and one copy to: SAMPLES COLLECTED DURING
FACILITY NAME Foss Recvcling, Inc. —Greenville, NC Facilitv Division of Water Quality CALENDAR YEAR: 2015
PERSON COLLECTING SAMPLES Tonv Jackson Attn: Central Files
CERTIFIED LABORATORY Pace Analvtical Lab # 12 1617 Mail Service Center
Lab # Raleigh, North Carolina 27699-1617
COUNTY Pitt
PHONE NO.( 252 ) 378-3166
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample
Collected
mo/dd/vr
Total
Rainfall
inches
00530
00340
00556
00400
01119
01114
01094
Total Suspended
Solids
m /I
Chemical Oxygen
Demand
m /I
Oil & Grease
m /l
pH
S.U.
Copper'
m /l
Lead'
m /I
Zinc'
m /I
Benchmark'
-
-
too
120
15
6.0-9.0
0.010
0.075
0.126
Outfall001
12/31/15
1.0
<13.4
35.0
<5.0
0.0338
<0.005
0.0304
If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
2 Total recoverable.
Only complete Part B if this facility uses more that 55 gallons of new motor oil per month.
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
No.
Date
Sample
Collected
mo/dd/ r
Total
Rainfall
inches
New Motor Oil
Usage
al/month
00530
00400
00556
Total Suspended
Solids
m /I
pH
S.U.
Oil & Grease.
m /I
Benchmark)
-
-
-
100
6.0-9.0
30
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law. that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system. or those persons directly responsible for gathering the
information, the information submitted is. to the best of my knowledge and belief, true, accurate. and complete. 1 am aware that there are significant penalties for submitting false information.
including the possibility of fines and imprisonment for knowing violations."
(Signature of
NCG200000 DMR
.)--1-) -16
(Date)
Form SWU-256
Page I of 1

aceAnalytical
www.pacelabs.com V `+`/
January 12, 2016
Chuck Hoffman
Mid -Atlantic Associates, Inc
409 Rogers View Court
Raleigh, NC 27610
RE: Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
Dear Chuck Hoffman:
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on January 04, 2016.
The results relate only to the samples included in this report. Results reported herein conform to the
most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless
otherwise noted in the body of the report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Nicole Gasiorowski
[e-mail]
Project Manager
Enclosures
cc: Ron Davis, Mid Atlantic Associatees, Inc.
G
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 1 of 13

Pace Analytical Services, Inc.
aceAnalytical
9800Kincey Ave. Suite 100
Huntersville, NC 28078078
ivrpece/abscan
[phone]
CERTIFICATIONS
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
Florida/NELAP Certification #: E87627
North Carolina Drinking Water Certification #: 37706
Kentucky LIST Certification #: B4
North Carolina Field Services Certification #: 5342
West Virginia Certification M 357
North Carolina Wastewater Certification #: 12
Virginia/VELAP Certification #: 460221
South Carolina Certification #: 99006001
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
North Carolina Wastewater Certification #: 40
Florida/NELAP Certification #: E87648
South Carolina Certification At 99030001
Massachusetts Certification #: M-NC030
West Virginia Certification #: 356
North Carolina Drinking Water Certification #: 37712
VirginiaNELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc.. Page 2 of 13

'ace Analytical
~vpacelabs.cwn
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project:
Pace Project No.:
FOSS RECYCLING, GREENVILLE
92281635
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92281635001
OUTFALL NO. 1
EPA 1664E
JMS
1
PASI-C
EPA 200.7
CDF
5
PASI-A
SM 2540D
MJP
1
PASI-A
SM 5220D
WRC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc.. Page 3 of 13

aceAnalytical o
wxw.pacalabs.com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
Sample: OUTFALL NO. 1 Lab ID: 92281635001 Collected: 12/31/15 10:30 Received: 01/04/16 09:20 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
HEM, Oil and Grease
Analytical Method: EPA 1664B
Oil and Grease
NO mg/L
5.0
1
01/05/16 07:39
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method:
EPA
200.7
Cadmium
NO ug/L
1.0
1
01/05/1618:00
01/0611616:51
7440-43-9
Copper
33.8 ug/L
5.0
1
01/05/1618:00
01/06/1616:51
7440-50-8
Iron
760 ug/L
50.0
1
01/05/1618:00
01/06/1616:51
7439-89-6
Lead
NO ug/L
5.0
1
0110511618:00
01/07/1615:38
7439-92-1
Zinc
30.4 ug/1-
10.0
1
01/05/16 18:00
01/06/16 16:51
7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
NO mg/L
13.4
1
01/05/16 14:05
5220D COD
Analytical Method: SM 5220D
Chemical Oxygen Demand
35.0 mg/L
25.0
1
01/09/16 12:00
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01/12/2016 03:25 PM without the written consent of Pace Analytical Services, Inc.. Page 4 of 13

*aceAnalytical
www.pecelabs.cam
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
QC Batch: GCSV/23741
Analysis Method:
EPA 1664B
QC Batch Method: EPA 1664E
Analysis Description:
1664 HEM, Oil and Grease
Associated Lab Samples: 92281635001
METHOD BLANK: 1640751
Matrix: Water
Associated Lab Samples: 92281635001
Blank Reporting
Parameter Units
Result Limit
Analyzed Qualifiers
Oil and Grease mg/L
ND 5.0 01/05/16 07:36
LABORATORY CONTROL SAMPLE: 1640752
Spike LCS
LCS %Rec
Parameter Units
Conc. Result
% Rec Limits Qualifiers
Oil and Grease mg/L
40 38.2
96 78-114
MATRIX SPIKE SAMPLE: 1640753
92281339005 Spike
MS MS %Rec
Parameter Units
Result Conic.
Result %Rec Limits Qualifiers
Oil and Grease mg/L
ND 40
35.3 88 78-114
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01/12/2016 03:25 PM without the written consent of Pace Analytical Services, Inc., Page 5 of 13

aceAnalytical"
wwwpacalaes.com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite too
Humersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
QC Batch: MPRP/20414 Analysis Method: EPA 200.7
QC Batch Method: EPA 200.7 Analysis Description: 200.7 MET
Associated Lab Samples: 92281635001
METHOD BLANK: 1641371 Matrix: Water
Associated Lab Samples: 92281635001
Parameter
Units
Blank
Result
Reporting
Limit
Analyzed Qualifiers
Cadmium
ug/L
ND
1.0
01/06/1616:30
Copper
ug/L
ND
5.0
01/06/1616:30
Iron
ug/L
ND
50.0
01/06/16 16:30
Lead
ug/L
ND
5.0
01/07/1615:32
Zinc
ug/L
ND
10.0
01106/1616:30
LABORATORY CONTROL SAMPLE:
1641372
Spike
LCS
LCS
% Rec
Parameter
Units
Conic.
Result
%Rec
Limits Qualifiers
Cadmium
ug/L
500
487
97
85-115
Copper
ug/L
500
494
99
85-115
Iron
ug/L
5000
4810
96
85-115
Lead
ug/L
500
488
98
85-115
Zinc
ug/L
500
468
94
85-115
MATRIX SPIKE & MATRIX
SPIKE DUPLICATE:
1641373
1641374
MS
MSD
92281549001
Spike
Spike
MS
MSD
MS
MSD
% Rec
Parameter
Units
Result
Conc.
Conc.
Result
Result
%Rec
%Rec
Limits
RPD Qual
Cadmium
ug/L
<1.0
500
500
484
485
97
97
70-130
0
Copper
ug/L
<5.0
500
500
506
499
101
99
70-130
1
Iron
ug/L
64.2
5000
5000
4900
4870
97
96
70-130
1
Lead
ug/L
<5.0
500
500
459
462
91
92
70-130
0
Zinc
ug/L
23.5
500
500
487
493
93
94
70-130
1
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01/12/2016 03:25 PM without the written consent of Pace Analytical Services, Inc.. Page 6 of 13

i
aceAnalytical"
wwwpacelabs.cam
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
QC Batch: WET/42308 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92281635001
METHOD BLANK: 1641028
Associated Lab Samples: 92281635001
Parameter
Units
Total Suspended Solids
mg/L
LABORATORY CONTROL SAMPLE: 1641029
Parameter
Units
Total Suspended Solids
mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
NO 2.5 01/05/1614:04
Spike LCS LCS % Rec
Conc. Result % Rec Limits Qualifiers
250 242 97 90-110
SAMPLE DUPLICATE: 1641030
92281640001 Dup
Parameter Units Result Result
Total Suspended Solids mg/L NO NO
SAMPLE DUPLICATE: 1641031
92281677001 Dup
Parameter Units Result Result
Total Suspended Solids mg/L NO NO
RPD Qualifiers
RPD Qualifiers
Results presented on this page are in the units indicated by the 'Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01/12/2016 03:25 PM without the written consent of Pace Analytical Services, Inc.. Page 7 of 13

aceAnalytical
wwwpecela6s.com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Hunterswile, NC 28078
[phone]
QUALITY CONTROL DATA
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
QC Batch: WETA/26005
Analysis Method: SM 5220D
QC Batch Method: SM 5220D
Analysis Description: 5220D COD
Associated Lab Samples: 92281635001
METHOD BLANK: 1642528
Matrix: Water
Associated Lab Samples: 92281635001
Blank
Reporting
Parameter Units
Result
Limit
Analyzed Qualifiers
Chemical Oxygen Demand mg/L
ND 25.0
01/09/16 12:00
LABORATORY CONTROL SAMPLE: 1642529
Spike
LCS
LCS % Rec
Parameter Units
Conc.
Result
%Rec Limits
Qualifiers
Chemical Oxygen Demand mg/L
750
796
106 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1642530
1642531
MS
MSD
92281843001
Spike
Spike MS
MSD MS
MSD
%Rec
Parameter Units Result
Conc.
Conc. Result
Result %Rec
%Rec
Limits
RPD Qual
Chemical Oxygen Demand mg/L 318
3000
3000 3300
3300 100
100
90-110
0
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1642532
1642533
MS
MSD
92281341003
Spike
Spike MS
MSD MS
MSD
%Rec
Parameter Units Result
Conc.
Conc. Result
Result %Rec
%Rec
Limits
RPD Qual
Chemical Oxygen Demand mg/L NO
750
750 801
801 105
105
90-110
0
Results presented on this page are In the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01/12/2016 03:25 PM without the written consent of Pace Analytical Services, Inc..
Page 8 of 13

aceAnalytical
www.pace/abs com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite too
Huntersville, NC 28078
[phone]
QUALIFIERS
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
10140I@ killOR69
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
PQL - Practical Quantitation Limit.
RL - Reporting Limit.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate %recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether, Styrene, and Vinyl chloride.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI -The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services -Asheville
PASI-C Pace Analytical Services - Charlotte
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2016 03:25 PM without the written consent of Pace Analytical Services, Inc.. Page 9 of 13

aceAnalytical
~..pacelabs.com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Hunlersville, NC 28078
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: FOSS RECYCLING, GREENVILLE
Pace Project No.: 92281635
Lab ID
Sample ID
QC Batch Method
QC Batch Analytical Method
92281635001
OUTFALL
NO. 1
EPA 1664B
GCSV/23741
92281635001
OUTFALL
NO. 1
EPA 200.7
MPRP/20414 EPA 200.7
92281635001
OUTFALL
NO. 1
SM 2540D
WET/42308
92281635001
OUTFALL
NO. 1
SM 5220D
WETA/26005
Date: 01/12/2016 03:25 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Analytical
Batch
ICP/18419
Page 10 of 13

/-/�aceAna lytical`
Client Name:
uocument
Project tf:
Courier: ed Ex UPS USPS Client
❑Commercial ❑Pace
❑Other: .
uocument I e%q$p; �uuta 2uap .
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Issui6gqutK4eItyi
Pace Huntersvli'Ie Qdality:0ffice.
,z
WO#:92281635
111111 111111I 111111 III
92281635
Custody Seal on Cooler/Box Present? []Yes QNo Seals Intact? []Yes ❑No I;
Packing Material: ❑Bubble Wrap ❑Bubble Bags []None ❑Other:
Thermometer ❑T1505 1'
Used: Type of lee: � eet r-pry•' L4v ❑Blue ❑None'' ampiA�ap`ice,"�ouling process has begun
Cooler Temp Corrected (°C)i 3 Biologicallrlssuaiozen?' ❑Yes ❑Noy ❑N/A'
Temp should be above freezing to 6°C Correction Factor: 0.0 °C Date and Initials of person Examinfng ont.njs.:' H
USDA Regulated Soil (❑.N/A, water sample) r_'...:
Did samples originate In a quarantine zone within the United States: CA, NY, or SC (check maps(? Did sd iiples originate from. -a e(4n source (Internationally
❑Yes [•]No' ,.
. Including Haivag anQ Pue: oRlc j2�:�.: ❑Yes QNo
If Yes to either auestien. fin me . aes,d�•aa e,.0 ��_.,.n-. '6
_ ..
...
-.._......
__..... :.
...
..
.. • ...'COMMENTS:: '. ..
Chain of Custody Present?
I as
QNO
N A
1.
• .i;•. `` �
Chain of Custody Filled Out?
❑Yes
❑N/A
�1,
n(• 1,M;(,''p/ dot( •,
.Chain of Custody Relinquished?
❑Yes
o
-6N/A
Sampler Name and/or Sinature onCOC7
❑Yes - 0 o
NA
4.
•'-.�: -
Samples Arrived within Hold Time?Elles
No
❑N/n
S.
_-
Short Hold Time Analysis 02 hr?
Yes.
l� o. ..:❑N/A
6..
'.•, .a,.; .,,,.. ;'�;,•+:: '.
M1'•
Rush Turn Around Time Requested?
QYes
No
N/A
7.'''`
Sufficient Valume7
❑Ye3/
bfr.'
.LNNu
ONIA
8.
! -:-• �' -+ -"•
. uc*ii .. � �, '{�. i'. " lV % •
,Correct Containers Used?.
Q.YCS
❑NO
❑N/A
9.
1p(I
ISrIV (I�
ucll Lei vw "6'r
•Pace Cpptalners Used?
es _.
No
❑N/A
Containers Intact?
es
ONO
N/A
10.
-
Filtered Volume Received for Dissolved Tests?
Des
QNO
E116A
11.
' Note If iediment Is visible in is ie diifolved container
Sample Labels Match COCY _ ..
❑Yes
b�
LyNo
❑N/A
12.
'}; tr V G'n oI I " faCtt 1 fib, ;� ' )p36:
-Includes Date/Time/ID/Analysis Matrix: V I
r
U ���'i:U� I
All containers needing add/base preservation have been
checked?
/
13.
- -
0 of s
[IN,
All containers needing preservation are found to be in
compliance with EPA recommendation?
(HNO3,H3SOc,HO<2;NaOH >9Sulfide,
- --
NaOH>12Cyanide)
0 es
[]No
❑N/A
....
Exceptions: VOA, Coliform, TOC, Oil and Grease,
DRO 8015 (water) DOC,LLH
es
QNo
[]N/A
Samples checkidfor dechlorization
es
[IN o
N/A
14.
".
Heads ace in VOA Vials (>5.6mm)7
Yes
❑No.
/A
15.+"'-''-•=--
Trip Blank Present?
❑Yes
[]NO
13 /A
16.
ss•, :�. :.,. . �.
Trip Blank Custody Seals Present?
[]Yes
�•` ":-'�
Pace Trip Blank Lot B(ifpurchased):
CLIENT NUTIFICATIUN/RESOLUTION'
Person Contacted:
Comments/Resolution:
Fleid Dataigequ(red? []Yes ❑No
Date/Tlme:
i
Project Manager SCURF Review;, I v cl Inx_ Date: Ir I �� I (.o
Note: Whenever there Is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (f.'e?9$ui bfof 13
hold, Incorrect preservative, out of temp, incorrect containers). 0\tkk

/ PaceAnalytical
CHAIN -OF -CUSTODY / Analytical Request Document
The Chai of -Custody is a LEGAL DOCUMENT. All relevant fields must foe completed accurately. N
`o
N
Section A Section B Section C or
PaBe: of
Rdgulmd Cliem IMormatwn: Required ProjM Information: Invoice Inlomlalio2 g
:omPany. Mid -Atlantic Associates, Inc. RePon To: Chuck Hoffman ([e-mail]) Adentiom Chuck Hoffman
address: 409 Rogers View Court
copy To: Ron Davis ([e-mail]
Company Name: Mid -Atlantic Associates, inc.
REGULATORY AGENCY
Raleigh, INC 27610
Address: 409 Rogers View Court, Raleigh, NC
r- NPDES r- GROUND WATER j DRINKING WATER
r UST f- RCRA i OTHER
_rnag To: [e-mail]
Pvmhase Omer No.: R2066.02
P. Quot. -
Ref.
'h°na: 919-250-9918
Faz: 919-250-9950
Project Nam: Foss Recycling, Greenville
P. Pmled Nicole Gasiorowski
Site Location
tamer
STATE:
NC
tequested W. Date ATa : randvd
Pro
Project NvmEer. R2066.00 Task 20000
-rJ � 1 _ 3
Requested
Analysis
Filtered
(YIN)
Section D valid MMAa Codes
-
a
Requtmd cnem mfamIDwn MATRI cow,
-
f
COLLECTED
Preservatives
D
N
Y
Y
Y
Y
Y
Y
Y
D.. .TER UW
U
2
WATER Wr
g
O
WASTEWATER WW
8-
V
COMPOSnE
MuPOWE
W
2
PROLt'KT P
Q
ST.WT
ENOGWtB
}
SOCSOLm SL
OM1 CA
SAMPLE ID
.
D_-
U'
w
p
r
�1
1")
(Ad. 691,) 0T 12R oT
o
a
a
H
Sample IDs MUST BE UNIQUE TISSUE Ts
O
a
i
m
[_g
Oz
d
o
jv
io
f
tC
a
a.
N
E
n
cm
O
Zx
U0
o
Q
H
DATE
TIME
DATE
ZZ
2
O
m
o
oC
Pace Project NoJ tab I.D.
•1
Ouffall No. 1
WT
G
6
z
1
1
2
x
x
x
x
x
x
x
X1
I
I
I
I
I Rainfall (inches): 1 1
2
H:
7
4
5
.6'
7
8
9
10
11
12
ADDITIONAL COMMENTS,
RELINQUISHED BY I AFFILIATION
DATE
TIME
ACCEPTEDBYIAMUATION
DATE
TIME
SAMPLE CONDITONS
Ld' .Cr. AA I
I/q/x,
czvo
S.3
E'
-
SAMPLER NAME AND SIGNATURE -
o
_
m $
_
az
ss
z
so
m,
PRINT Name of SAMPLER:
'
m
F
-
c
SIGNATURE of SAMPLER:
GATE Signed
(MWDDII'YI:
Ld
ro
•Impanam Ndle: 8y Syniig IDla rartn you am acceplinp Pxe's NET ed dry p N to n and agme°q to Ue d 501 1.5% per rtmmR for oM invokes rot paW rvdRn b daya. F-ALL-0-020rev.06. 12-Oct-2007

hCGro �b31'
Analytical Results
Bay State Milling Co.
Post Office Box 358
Mooresville, NC 28115
Receive Date: 06/04/2015
Reported: 06/17/2015
For: Stormwater
Comments:
Sample Number Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
150604-19-01 Chemical Oxygen
#1
70
mg/L
HACH8000
06/10/2015
CL
Demand
150604-19-01 Oil and Grease
#1
21.7
mg/L
EPA1664RevB
06/1512015
MD
150604-19-01 TSS
#1
22.286
mg/L
SM254OD-1997
06/05/2015
WL
150604-19-02 Chemical Oxygen
#2
60
mg/L
HACH8000
06/10/2015
CL
Demand
150604-19-02 Oil and Grease
#2
6.7
mg/L
EPA1664RevB
06/15/2015
MD
150604-19-02 TSS
#2
10.286
mg/L
SM254OD-1997
06/05/2015
WL
Respectfully
submitted,
0
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2

Condition of Receipt
Temp on
Sample Number 150604-19-01 Arrival: 2
Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Chemical Oxygen Demand
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Temp on
Sample Number 150604-19-02 Arrival: 2
Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Chemical Oxygen Demand
Sulfuric Acid Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 2

Client://C /-%
ANALYTICAL
Address: 51 �f /i / /y/ /1 / , ) L� -
T a ��/ ,// Ir/ /V c7
WSTATESVILLE
122 Court street • 1'0. Box 228
Statesville. NC 28687
N C,
[phone]
'
Contact Person: �— / /^��� `'L Phone # r7()u �l1�� 3
IBA l� /�o7
7by:
FAX#20y%gl
Chain of y
Po # - Requisitioned � (Time tCustody
Record
Customer
Sample ID#
Lab -ID #
Time Sampled
(Grab Only)
Date Sampled
(Grab Only)
a
-
u
Matrix
'
Parameters requested for analysis -
snmsa
w
150(oGu I�-UI
�:is
(o/�jis
�7�G
t
I
I
TS5
l .
I
CUJ
M-02
.8•:2,2
I
�
1j 1
Tn5
I
1
coo
Relinquished by: 3 y l�t/Jf�O��L L�
TimY Cam, pm Date 7 //S
Sampled by:
Received by:
Time LJ5-B am; pm Date �/ �/�5
Transported by:
l/
Relinquished by:
Time
am, pm Date _/_/_
Holding times met:
Received by:
Time
am, pm Date
Compliance work:
Composite Sampling #1:
Time begin pm Date
Non-compliance work:
_
Time end %.rid aim pm Date r / /26
Lab Comments:
Composite Sampling #2:
pL1/
Time begin Qria pm Date
6
17��
(."75
Time end 6 %R) am, pm Date 6/ 7/ A